The role of metaphor in transforming the inhabited experience of life-threatening illness
  • Carolyn Rickett, Judith Beveridge, Jill Gordon and Paul Race
Abstract

But most often someone writing a poem believes in, depends on, a delicate, vibrating range of difference, that an ‘I’ can become a ‘we’ without extinguishing others, that a partly common language exists to which strangers can bring their own heartbeat, memories, images. A language that itself has learned from the heartbeat, memories, images of strangers. (Rich 2003: 86)

The New leaves writing project was designed to provide people experiencing life-threatening illnesses the poetic tools to help gain self-confidence, literary skills and some kind of aesthetic satisfaction by creating their own poems. Because poetry often utilises the language of the subconscious, it has a unique capacity to help people uncover and listen to the deeper meanings of their lives (Harrower 1972; Mazza 1999). Poetry enables people to feel their lives, rather than to withdraw, or retreat into emotional numbness or states of paralysis in times of crisis. Participants in our project found writing poetry helped build an interior space and – when undertaken in a group led by Judith Beveridge, who is an experienced practitioner – connect their work to a wider community. This article focuses on the ways in which the creation of metaphors and symbolic images enabled New leaves poets to represent the knowledge and experience of illness while moving dialogically from an isolated ‘I’ to a connected ‘We’ by participating in the workshop and publication process.

Keywords: New leaves writing project – poetry – illness – wellbeing – practice-led research

Introduction: inhabiting (poetic) language
In a poem entitled ‘Words’, Wendell Berry poses two central questions that invite a consideration of the desire to inhabit language:

What is one to make of a life given
to putting things into words,
saying them, writing them down?
Is there a world beyond words?

His response:

There is… (2005: 20).

In the next movement of the poem, Berry explores the world of stillness and silence, but returns to affirm an impulse of using language as a means of location and orientation:

we must call things by name
out of the silence again to be with us,
or die of namelessness. (2005: 20)

While Berry’s poem is not specifically navigating what it means to speak or write of an illness experience, it nonetheless highlights a fundamental human need, especially when confronted by a life-threatening disease, to be more than a voiceless observer. Intrinsic to our sense of security, is our ability to name what we most value, and to name conversely what immediately threatens us: to inhabit language and use it for strategic ends.

Implied in Berry’s poem is the driving motivation to come back from isolation to participate again in the social act of narrating and naming. Yet, a traumatic experience can shrink the largesse of language into a struggling stammer. This conundrum of needing to speak of a crisis and the shock and fear that potentially exceed the limits of telling is familiar to those who have experienced a cancer diagnosis or cared for someone with the disease. As medical practitioner and poet, Raphael Campo observes:

at the moment of diagnosis, the whole world stops. With the label the doctor places on the symptoms, pronounced matter-of-factly, it is the most crucial juncture in the story of an illness – when the now-‘patient’ most risks losing control of his or her narrative. (2003: 77)

Because, as Campo points out, ‘the word ‘patient’ shares its Latin root with ‘passive’” (2003: 77), writing might be regarded by some patients as an active way of supplanting medical discourse with the voice of an individual. Academic researcher and expressive writing facilitator, Gillie Bolton notes that ‘Poetry, even when it concerns death, pain, disfigurement, despair, is vibrant, alive, a way of life’ (1999: 130), and this complex alchemy describes the regenerative possibilities we believe writing might have for people experiencing life-threatening illnesses. There is now a long-established tradition of poetry being used in therapeutic contexts (Harrower 1972; Mazza 1999, 2017) and the ways in which ‘language, story and symbol’ can help build a person’s capacities (Mazza 2012: 1434).

The New leaves writing project: practice-led research
As academics working in the area of communication, medical humanities, health and creative practice, we have sought tangible ways in which the process of ‘inhabiting language’ might assist people dealing with the grief and complexity of a disease that threatens their mortality. Central to our practice-led research was the establishment of a pilot study called the New leaves writing project where participants with a history of serious illness, usually cancer, undertook a poetry writing course with Judith Beveridge, a respected poet and university lecturer. Our goal was to provide similar access to the skills development and writing workshops tertiary students experience in Judith’s poetry classes and offer this opportunity to people who, due to their illness and life circumstances, were not typically able to enrol in a poetry writing unit at university.

Another objective of the research team was to see what effect writing might have on the participants’ sense of wellbeing. What made this pilot study different to a number of other writing workshop initiatives that are run for people in crisis is that the research design included robust empirical data rather than solely relying on the method of subjective self-reporting. The results of our study showed an increase in the participants’ sense of wellbeing over the duration of the writing workshops.1

Of course, writing poetry could not cure those with a terminal diagnosis, but the creative space enabled people to find their own words and metaphors to express individual perceptions and lived experiences. In this particular context, the project unequivocally confirmed for us previous scholarship exploring the role inhabiting language might play in emotional healing and underscored the therapeutic value writing poetry can have in times of crises (Harrower 1972; Mazza 1999).

One of the participants, who had not written expressively before, said he felt he had been ‘driving trauma around’ for so many years, and that now his new-found skill of writing poetry had given him ‘a place to park it.’ His father had been diagnosed as ‘terminal’ when he was a young man, but the family were not allowed to say the word ‘cancer’; his illness was not to be named. The family were not permitted to witness his suffering. Like his father, the project participant was later diagnosed with cancer, but in a different time and culture his family attentively listened to and participated in his story. This man’s story, like many of the other participants’, found expression in poetic language and was included in the New leaves anthology; a poetry book which showcases the work of the participants alongside the voices of some of Australia’s high-profile poets.

The concept of ‘new leaves’ as a generative image for a writing project drew its conceptual inspiration from Richard Aldington’s four-line epigram entitled ‘New Love’ where the poet describes an almond tree that has new leaves after being damaged by frost. At the heart of the New leaves project was ‘… the creation of a supportive poetry workshop where participants could, if they chose, create and narrate poems about encounters with life-threatening illnesses’ (Beveridge and Rickett 2008: xi). Importantly though, as the preface of the anthology highlights, inhabiting language enabled poets to produce creative artefacts informed by a myriad of authorial motivations:

A number of poems in this anthology are narratives in which the work of re-framing grief, rage and protest in relation to illness is at work. The act of writing poetry can promote transparency, self-reflection and revelation which in turn become part of recuperating and validating personal meaning: the important process of making something new. (Beveridge and Rickett 2008: xi)

Importantly too, the following observation signals the complexity and importance of the collaborative published outcome:

The writers of the poems in this anthology, who poignantly convey what is often ‘unspeakable’ or ‘unknowable’ when life is actively threatened, offer new insights for those of us who have not experience very serious illness. However, they do offer celebratory poems that speak of other places and experiences beyond illness and crisis. (Beveridge and Rickett 2008: xi)

As Judith Beveridge notes in a reflection on teaching the course of poetry writing for the New leaves participants, ‘[I] felt both excited and daunted. Excited because I love bringing poetry to people, and daunted because I wasn’t sure how I would cope among a group of people who had undergone severe suffering’ (Beveridge and Rickett 2008: xiii). However, she soon discovered ‘participants were eager, responsive and keen to get on with the business of learning about poetry’ (xiii). Judith also commented that ‘instead of feeling diminished by poetry, as some people do when confronted with a poem they can’t understand, group members used the poems and their own writing as a means to enlargement’ (xiii).

In positioning poetry as ‘a means to enlargement’ Seamus Heaney, in his inaugural Oxford University lecture series entitled ‘The Redress of Poetry’, suggests something we also found in our own context during the New leaves writing workshops:

Poetry … has to be a model of active consciousness. It has to be able to withstand as well as to envisage, and in order to do so it must contain within itself the co-ordinates of the reality which surrounds it and out of which it is generated. When it does contain these co-ordinates, it becomes a power to which we can have recourse …. (1990: 11)

Heaney’s framework suggests that it is not only through reading but also writing poetry – inhabiting this medium – a poet can have ‘recourse’ to telling and reasserting a self with agency.

Importantly, Judith highlights aspects of the participants’ process of enlarging their consciousness, and the ways language could be focused to articulate self-selected content:

Not all participants wanted to write about their illness, but rather express their love of family and friends and on many occasions, their love of their pets. Some wanted to go back in time to places and to childhood experiences that has been of vital importance to them. The participants who did write about illness were overjoyed to be able to find metaphors that helped them express their own truths. On many occasions it was the sense of surprise, the fact they had been able to find their own deeply personal images, words and rhythms, that they could bring their own voice to life which was remarkably joyful and healing (Beveridge and Rickett 2008: xiv).

The breadth of unexpected themes and privileging of diverse experiences shared in the poetry workshop and the publication of an anthology created a space of imaginative expansion at a time when many participants where experiencing the limiting and reductive confines of biomedical discourse.

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Figure 1. Photo credit: Ann Stafford.

Painful experiences and life-affirming narratives
Along with delivering an address at the New leaves anthology book launch, author and commentator Peter FitzSimons wrote in the foreword that:

All of us who are healthy can get so easily lost in the hurly burly of day to day existence where we can mistakenly grant great importance to complete nonsense … and really give a stuff what kind of car we drive, and whether or not our favourite football team made it to the semis … what comes through in these poems, written by people who are going through, or just coming out of great illness, is enormous wisdom and appreciation of what really matters – family, sunny days, friendships, reaching out. (2008: xv-xvi)

The themes that FitzSimons identifies are imaged through literal recount in some poems, and more metaphorical representations in others. What we found imaginatively rewarding throughout this writing project were a number of resistances to clichéd representations of cancer, and the innovation of new metaphors such as ‘uninvited interloper’ and ‘ribbons of love’ to describe an experience of illness and the unbreakable bond with family.

Importantly, Susan Sontag’s Illness as metaphor and AIDS and its metaphors helped inform our starting place for the project where writing might serve as a strategic (and therapeutic) way for participants to write back to illness and subvert cultural stereotypes. Sontag strongly resists the idea of using metaphorical language to represent illness arguing ‘that illness is not a metaphor, and that the most truthful way of regarding illness – and the healthiest way of being ill – is one most purified of, most resistant to, metaphorical thinking’ (1991: 3). Her lament ‘it is hardly possible to take up one’s residence in the kingdom of the ill unprejudiced by the lurid metaphors with which it has been landscaped’ (1991: 3) was also echoed by some of the participants. Publishing her work in the late 1970s, Sontag was not only dealing with her own experience of breast cancer and its medical treatment, but also the collective representations of cancer which she found deflating.

Many of the negative and punitive tropes describing cancer that she critiqued still shape our cultural discourse decades later, and remain residual tropes many of the participants were still navigating decades on. For Sontag, cultural language about cancer had been radically impoverished because the disease was (and still is) fundamentally figured in metaphorics connected with combat. She writes: ‘The controlling metaphors in descriptions of cancer are, in fact, drawn not from economics but from the language of warfare: every physician and every attentive patient is familiar with, if perhaps inured to, this military terminology’ (1991: 65). Sontag further comments:

Treatment also has a military flavor. Radiotherapy uses the metaphors of aerial warfare; patients are ‘bombarded’ with toxic rays. And chemotherapy is chemical warfare using poisons. Treatment aims to ‘kill’ cancer cells (without, it is hoped, killing the patient). (1991: 66)

However, in a personally re-imagined metaphorical space, one of the New leaves participants wrote a poem entitled ‘Radiotherapy’ where instead of ‘bombardment’ she likens her treatment by medical practitioners to a sacred encounter:

Holy hands are hovering over me,
Gently, firmly, purposefully.
I imagine the hands belong to temple priestesses
Dedicated to acts of service in the name of Healing. (Fitzmaurice 2008: 83)

The traditional imagery of war and the militarisation of cancer that Sontag critiqued as the universally invoked descriptors of illness, has been transformed by this poet, and pejorative battle comparisons resisted. Another project participant moved beyond the linguistic confines of combat to choose a different metaphor to represent the ambiguity surrounding her cancer journey:

Uncertainty – a wet dog huddled beside me;
a constant, uncomfortable distraction.
Peeping from behind shuttered windows,
the house next door watches life flow on.
The dank smell of a wet dog
hangs,
trapped in the empty hallway. (Witt 2008a: 5)

The participants in the project were often able to externalise some of their complex feelings by creating metaphors that aligned with deep and visceral associations. As psychotherapist Ellen Siegelman elucidates, ‘in moments of strong, inexpressible feeling, [we] find ourselves cleaving to metaphor to communicate experience that is hard to convey in any other way’ (1990: 1). Another project participant entitled a poem about her diagnoses as ‘The Uninvited Interloper’. She writes:

You came into my house one day,
Just how did you get in?
I didn’t know you had come to stay
I wanted you to go away,
I didn’t ask you in (Saar 2008: 107)

Creating and evoking a direct metaphor of cancer as an ‘uninvited interloper’ she is able to assert her sense of agency through a recourse to writing:

Go down the path and through the gate
Don’t hesitate, or ponder.
Get to the bus stop, stand and wait
I’ll watch you from the garden gate
Until you’re there no longer.

Then back into my house I will march
And throw away your pillow,
I’ll strip the bed, I’ll clean the bath,
I’ll vacuum floors and sweep the path
And open wide the window. (Saar 2008: 107)

Instead of a patronising representation of a cancer ‘victim’, the poet insists on her own boundaries, her own expansive capacities, and claims her own space in and through language. 

‘I’ and a connected ‘We’
Responding to Sontag’s ‘elegant analysis of how we think about illness and the stigma we attach to it’ (1993:18), writer of Intoxicated by illness, Anatole Broyard offers this summation: ‘In my opinion she’s too hard on metaphor ... While she is concerned only with negative metaphors, there are positive metaphors of illness too, a kind of literary aspirin’ (1993:18). Broyard’s notion of metaphor functioning as a positive literary intervention, is a process we witnessed directly during the New leaves writing project:

Metaphors may be as necessary to illness as they are to literature, as comforting to a patient as his [or her] own bath robes and slippers. At the very least, they are a relief from medical terminology. If laughter has healing power, so too, may metaphor. Perhaps only metaphor can express the bafflement, the panic combined with the beatitude, of the threatened person. (Broyard 1993: 18)

Having observed the kind of recuperative power of metaphor that many of the poems in the New leaves anthology reflect, we are in alignment with Campo’s view that for some people it is precisely ‘metaphorical thinking’ that enables an ill person to detail specifics of their circumstance and progress some form of emotional healing. Importantly, Campo also identifies one of the prime benefits of this type of inhabiting and envisioning: ‘Poetry … transcends the limitations of derivative language … and may rather create through more positive constructions opportunities for healing that utilize powers of the imagination …’ (2003:188). In order to offset the threat posed by cancer, we find a number of the participants’ poems performing a kind of therapeutic function as described by psychiatrist and poetry therapist Kenneth Gorelick:

Poetry contains and unleashes the power of metaphor. It juxtaposes one thing with another, exchanges meanings, and opens up new possibilities and understandings. A metaphor is itself and something else at the same time. It enlarges, it connects, it shatters old frameworks. (2005: 123-124)

As researchers and creative practitioners, we witnessed the shattering of ‘old frameworks’ and the re-imaging of new ones through the process of writing and workshopping poetry in community. Judith Beveridge notes:

When people undergo severe trauma and crises, poetry can help them come to terms with their experiences and feelings and enables a ‘correction’ to take place. Through poetry, we can gain clarity and a new sense of perspective on painful experiences. (2008: xiii)

Developing, sharing ideas and drafting poetry in a group setting enabled a distillation and articulation of feelings and responses that allowed for new ‘possibilities and understandings.’

An elderly participant’s experience in the New leaves group testifies to the way in which writing poetry can be expansive and emotionally recuperative. In her first interview at the start of the program she reflected on the trauma of her illness:

I feel as though I’ve gone up in an explosion, come down in pieces, and people have put the things together in the right order … but what came out at the end is not the one that went in … I find it very hard to link ‘what was’ and ‘what is’ … it’s still difficult.’  After she completed the program she offered this insight: ‘[Writing] gave me more control … I could take hold of it ... and put it where I wanted it ... I put it in the book ... deliberately, and closed the book – deliberately.

Her engagement with writing poetry about her traumatic experience highlights the process that Reinekke Lengelle and Frans Meijers investigate in a journal article entitled ‘Mystery to mastery: An exploration of what happens in the black box of writing and healing’. They maintain that writing functions as a therapeutic modality when it enables a person to ‘work toward a more life-giving perspective’ which ‘may include a shift in perspective, acceptance, or meaning found/constructed’ (2009: 59).

Conclusion
A number of participants commented they found the poetry writing course with Judith more useful than a cancer support group because the selected poetry readings and workshops focused on significant existential explorations rather than simply dealing with the details of and treatment modalities for their illnesses. Many echoed the observation that using figurative language created a vehicle for reflecting on their lives. We also observed that often ‘by speaking in metaphoric language [people] are able to safely discuss issues that are often too distressing to address directly’ (Furman et al 2002: 150). The development of writing skills enabled participants to address some of the issues they were facing, and articulate individual rather homogenous depictions of illness. In building this linguistic capacity in community with each other, ‘they saw the poetry writing group as not simply a support mechanism, but a serious challenge to their intellects and creativity’ (Rickett, Greive and Gordon 2011: 275).

When previously publishing the qualitative and quantitative research findings from the New leaves project in the journal of Australasian Psychiatry, we made this comparative observation:

Both writing and psychotherapy provide an opportunity for each individual
to create a ‘second story’ that makes sense of experience, especially when
a life-threatening illness has suddenly removed all sense of control. Working
in a group creates an inner/outer dynamic that can help people to make
sense of illness. In addition, poetry involves the creation of an enduring
physical object that can be shared with others. (Rickett, Greive and Gordon 2011: 265)

The continuity of the participants’ poetry objects through the publication and circulation of the anthology was a heartening aspect of the project. One of the participants died a few months after the anthology was launched, and in a reflection entitled ‘Writing and wellbeing’ she wrote for the hospital’s The Word Is Out newsletter she acknowledged that ‘Poetry has given me an outlet to try to untangle some of the confusion within’ (Witt 2008b: 3). Importantly she shared insights into her process, and affirmed the enduring legacy of her creative contribution:

The first poem I wrote for the group, ‘Uncertainty’ helped me get in touch with the emotional impact of living in limbo; not knowing what the future holds for my family and me. The second poem, ‘Ribbons of Love’ was written for my teenage daughters as I struggled with a difficult prognosis and the fear of leaving them behind. The process of writing and unpeeling the layers helped me to see beyond the fear to the truth behind it; to the incredible connection we share as mother and daughters, something that will remain strong. Both girls have this poem framed in their bedrooms and it’s very special to me that I have been able to convey my depth of love to them in a way that will stay with them into the future’ (Witt 2008b: 3)

While there was no cure for her cancer, there is a very particular sense that a kind of healing was enacted in ‘Ribbons of Love’ through the celebration and continuity of her written words:

These ties are strong, sure and fast.
Dangling with possibility –
They are vines to swing from, cords to spring from,
ropes for climbing, or sailing, or skipping.
Use them in life to secure a load or lasso your dreams.
Clip them onto your belts if needed for safety,
or knot colourful strings on your fingers to remind you
to be kind to yourself. (Witt 2008c: 77)

The energised and life-affirming images of Michelle’s final poem offer the reader an invitation to live and love with optimism and generosity.

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Figure 2. Project participant Michelle Witt presenting Judith Beveridge with a gift from the New leaves writing group. Photo: Carolyn Rickett

End notes

  • 1. The results from this pilot study have been published in a journal article co-authored by Carolyn Rickett, Cedric Greive and Jill Gordon. The article entitled “Something to hang my life on: the health benefits of writing poetry for people with serious illness” can be found in Australasian Psychiatry.
Works cited: 

Berry, W 2005 Given: new poems, Berkley: Counterpoint

Beveridge, J and Rickett C 2008 (eds) New leaves anthology, Sydney: Darlington Press

Bolton, G 1999 ‘“Every poem breaks a silence that had to be overcome”: The therapeutic power of poetry writing’, Feminist Review 62, 118-133

Broyard, A 1993 Intoxicated by my illness, New York: Ballantine Books

Campo, R 2003 The healing art: A doctor’s black bag of poetry, New York: WW Norton

Fitzmaurice, J 2008 ‘Radiotherapy’, in J Beveridge and C Rickett (eds), New leaves anthology, Sydney: Darlington Press

FitzSimons, P 2008 ‘Foreword’ in J Beveridge and C Rickett (eds), New leaves anthology, Sydney: Darlington Press

Furman, R et al 2002 ‘Poetry as a tool for strengths-based practice’, Advances in Social Work 3: 2 (Fall), 146-157

Gorelick, K 2005 ‘Poetry Therapy’ in Cathy A Malchiodi (ed), Expressive therapies, New York: The Guilford Press, 117-140

Harrower, M 1972 The therapy of poetry, Springfield, IL: Charles C Thomas

Heaney, S 1990 The redress of poetry, Oxford: Oxford University Press

Langelle, R and Meijers, F 2009 ‘Mystery to mastery: An exploration of what happens in the black box of writing and healing’, Journal of Poetry Therapy, 22:2, 57-75

Mazza, N 1999 Poetry therapy: Interface of the arts and psychology. Boca Raton: CRC Press

Mazza, N 2012 ‘Therapy and Poetry’, in R Greene et al (eds) The Princeton encyclopedia of poetry and poetics, Princeton, NJ: Princeton University Press, 1434-1435

Mazza, N 2017 Poetry therapy: Theory and practice, 2nd ed, New York: Routledge

Rich, A 2003 ‘Someone is writing a poem’ in What is found there: Notebooks on poetry and politcs, New York: WW Norton

Rickett, C, Greive, C and Gordon, J 2011 ‘Something to hang my life on: The health benefits of writing poetry for people with serious illnesses’, Australasian Psychiatry 19.3, 265-268

Saar, P 2008 ‘The uninvited interloper’, in J Beveridge and C Rickett (eds), New leaves anthology, Sydney: Darlington Press

Siegelman, E 1990 Metaphor and meaning in psychotherapy, New York: The Guilford Press

Sontag, S 1991 Illness as metaphor and AIDS and its metaphors, London: Penguin Books Ltd

Witt, M 2008a ‘Uncertainty’, in J Beveridge and C Rickett (eds), New leaves anthology, Sydney: Darlington Press

Witt, M 2008b ‘Writing and Wellbeing’ in The Word Is Out, at
https://www.sah.org.au/assets/files/PDFs/Cancer%20Support%20PDFs/2008%20Spring%20Word.pdf (accessed 22 September 2018)

Witt, M 2008c ‘Ribbons of Love’ in J Beveridge and C Rickett (eds), New leaves anthology, Sydney: Darlington Press

 

Acknowledgements

Thank you to the New leaves project participants. This practice-led research was supported by a small grant from the Australasian Research Institute, the Sydney Adventist Hospital. The members of the original New leaves writing group are still meeting to write and share poetry a decade on from the first pilot study.